Revised 6/6/2018 Membership Application - USA …

1 IMPORTANT - PLEASE TYPE OR PRINT CLEARLY all requested information. Refer to the back of this page for further details on Membership types and insurance coverage. If you are signing up for Membership at a USA Water Ski & Wake Sports (USA-WSWS) sanctioned event, please use our Event Membership Application so that we may backdate your Membership to the beginning of the sanctioned event rather than the date your Application is INFORMATIONM embership #: (renewing members only)Full Name:Birth Date (mandatory) Gender: q Male q Female E-Mail Address:Sport Discipline:1st Choice (mandatory)2nd Choice*Foreign Federation: * Federation ID Number.

2 Club/School:Mailing Address:City/State/Zip+4:Country:Contact Phone:( ) (mandatory) q home q work q mobileINDIVIDUAL OR FAMILY Membership FEE FROM ABOVE:$Complete this section only if you selected Family Membership status above. Provide the names and requested information for up to five family members (spouse and depen-dent children age 17 and under) who reside at the same address. Spouse/Dependents Full Name(children age 17 & under living at same address) Membership Number(renewing members)Birth Date(mandatory)GenderSport Discipline1st choice/2nd choice(see list of disciplines)AmountDueSpouse/ChildM Preserve our Sport s History, Support our Athletes and Celebrate our Heroes!

3 Join the USA Water Ski & Wake Sports Foundation .. $25:$TOTAL AMOUNT DUE:$ Membership INFORMATION *FOREIGN FEDERATION AND ID NUMBER: If you are a member of a foreign federation, please provide your home federation and skier license number. This information is re-quired for members competing in USA-WSWS sanctioned 3-event tournaments who wish to have their performances therein passed to IWWF for inclusion on the IWWF ranking lists. If you do not know your number, go MEMBERSHIPS: The Active Membership types listed below MAY participate in USA-WSWS sanctioned (25 and Older) q One Year ..$ 80 q Two Years (Save $10) ..$150 q Three Years (Save $24).

4 $216 q Five Years (Save $50) ..$350q Under 25 Active ..$ 50q GrassRoots Active (restrictions on back) ..$ 35 q Family Active (up to 6) ..$175 Head of household and up to five additional family members (spouse/dependent children age 17 & under) who reside at the same address. SOCIAL/SUPPORTING Membership : Social/Sup-porting members MAY NOT participate in USA-WSWS sanctioned Social/Supporting ..$ (see list of sport discipline codes below)MEMBERSHIPS ARE NON-REFUNDABLE(last 3 digits on back of card)FAMILY INFORMATIONFor Office Use OnlyMembership Application1251 Holy Cow Road, Polk City, Florida 33868-8200(863) 324-4341 Fax: (863) 325-8259 Email: 6/6/2018 PAYMENT INFORMATION: q YES, my signed ANNUAL Waiver Agreement(s) are attached for each Active member.

5 Active memberships will not be considered active unless a signed Annual Waiver and Release of Liability form is received with Membership . WAIVERS MAY NOT BE FAXED. q Check/MO (made payable to USA Water Ski & Wake Sports) q Credit Card Cardholder s Name Credit Card # Exp. / CVV# CC Billing Address City State Zip Code Signature Thank you for your Membership !

6 Sport DisciplinesAWSABCNCWWSDUSHAKANSSNWRUSWYo ur selection of a sport discipline preference directly affects each sport discipline s representation on the USA-WSWS board of directors. Slalom/Tricks/Jumping Barefoot Collegiate Slalom/Tricks/Jumping Disabled Hydrofoil Kneeboard Show Ski Ski Race Wakeboard/Collegiate WakeboardCheck out our merchandise at !USA WATER SKI & WAKE SPORTS**All memberships expire 12 months from purchase HEADQUARTERS1251 HOLY COW ROADPOLK CITY, FL 33868(863)324-4341 SUPPORTING MEMBERA New Affordable Membership Option forRecreational Water Sports Enthusiasts with anAttractive Benefits Package:- Connect with our members, clubs, manufacturers, coaches and events- Receive an annual subscription to The Water Skier magazine - Receive eNewsletters to stay up to date on the latest events, news and more- Access exclusive Members Only discounts on gear, travel, apparel and more *May not participate in sanctioned events $per personWANT TO JOIN THE COMMUNITY?

7 CHOOSE A Membership THAT'S RIGHT FOR YOU!Active members are eligible to receive secondary medical expense coverage of up to $10,000 (subject to a $1,000 deductible) for accidental injuries sustained during participation in sanctioned more details regarding the insurance provided by USA Water Ski & Wake Sports in connection with sanctioned events, please refer to the Insurance Fact Summary, which is available at under Insurance MEMBERSHIPE ligible to participate in Basic Skills Clinics, Practices & Exhibitions.$7 May not go over the TODAY!Join/Renew online YOUR FRIENDS!Revised5/15/18 Active Members are eligible to participatein a variety of sanctioned events based on Membership Connect with our members, clubs, manufacturers, coaches and events- Receive an annual subscription to The Water Skier magazine- Receive the Regional Tournament Guide (for all members indicating AWSA, NCWSA or WSDA; otherwise available by request) - Access exclusive Members Only discounts on gear, travel, apparel & more- Receive eNewsletters to stay up to date on the latest events, news & moreChoose a Membership below that s best for you!

8 ]ACTIVE MEMBERSHIPSUNDER25 ACTIVE$50- Participate in any sanctioned event25&UP ACTIVE$80- Participate in any sanctioned eventFAMILY ACTIVE$175- Up to 6 family members residing at the same address; children 17 and under- Participate in any sanctioned eventGRASSROOTS ACTIVE$35- Participate in only GrassRoots events, Basic Skills Clinics, and club practices/exhibitions- May not go over the jumpF:\membsvcs\Forms\2018\ Membership Options\ Membership Options - Rev. WAIVER AND RELEASE OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT ANNUAL Membership Waiver Form for ADULTS (Age 18 or older) In consideration of USA Water Ski & Wake Sports, Inc.

9 ( USA-WSWS ) allowing me, the undersigned, to participate in any USA-WSWS sanctioned event, including, but not limited to, any tournaments, clinics, shows, exhibitions, races, competitions, practices and related activities sanctioned by USA-WSWS (the Event or Events ); I, for myself, and on behalf of my spouse, children, guardians, heirs and next of kin, and any legal and personal representatives, executors, administrators, successors and assigns, hereby represent, contract and agree to the terms of this Waiver and Release of Liability, Assumption of Risk and Indemnity Agreement (the Agreement ); 1. I represent that (i) I am at least eighteen (18) years of age or older; (ii) I am in good health and in proper physical condition to participate in the Event(s); and (iii) I am not under the influence of alcohol or any illicit or prescription drugs which would in any way impair my ability to safely participate in the Event(s).

10 I agree that it is my sole responsibility to determine whether I am sufficiently fit and healthy enough to participate in the Event(s), that I am responsible for my own safety and well-being at all times and under all circumstances while at each Event site. 2. I understand, acknowledge and assume the risks and dangers associated with participation in the sport of water skiing, wake sports and related water sport disciplines and activities, including without limitation, the potential for serious bodily injury, sickness and disease, permanent disability, paralysis and loss of life; loss of or damage to equipment/property; exposure to extreme conditions and circumstances; contact with other participants, spectators, boats, animals or other natural or manmade objects; dangers arising from adverse weather conditions; imperfect ski course conditions; water and surface hazards.